Fistic Medicine: Lesnar’s Illness & Recovery

When Brock
Lesnar pulled out of his title defense for health reasons in
October, there was little alarm: These things happen in fight
sport.

The initial reports on Lesnar's illness were unfathomable to those
of us in medicine, though. A robust man in his early 30s laid low
by a normally trivial disease of the elderly? Many of us suspected
Dana White was indulging in some over-the-top hype.

Today,
the truth came out. And, for once, White’s hyperbole was
insufficient for the gravity of the situation.

Diverticulitis is an infection involving the colon, generally the
extreme end portion known as the distal and sigmoid colon. The
normal course of the disease involves low-grade fevers, loose
bloody stools and abdominal pain followed shortly by relatively
easy diagnosis, treatment with oral antibiotics and swift recovery.
A previously healthy individual would certainly be laid up for a
week or so, and a professional fighter might be unfit for
high-level training for as long as a month. But Lesnar’s
diverticulitis wasn’t diagnosed early, and he was absolutely right
when he stated on “SportsCenter” that he very nearly died.

The complication Lesnar suffered was a bowel perforation, a
pus-forming infection eroding through the wall of the colon. If the
perforation is contained, medical treatment and percutaneous
drainage generally result in full recovery. If the perforation is
not contained, if large volumes of pus and stool spill into the
abdominal cavity, then emergency surgery is the only hope for
survival and death is an expected outcome. At best a patient could
expect to lose all or part of his colon and be incapacitated for
years. It appears, from what Lesnar explained on “SportsCenter,”
that he was diagnosed on the razor-thin border between these two
extremes.

If he had gone to surgery, all or part of the colon would have been
removed. The healthy bowel would be diverted to a hole in the
abdominal wall -- a “fistula” -- so stool could have been drained
into a colostomy bag. After a period of recovery, taking many
months, it’s possible the colostomy could be reversed -- allowing
normal function of the bowel -- but the recovery from this second
surgery would again require several months. If reversing the
colostomy were not feasible, Lesnar would have been bound to wear a
colostomy bag for life; training for MMA, much less competing,
would have been impossible.

The question now is what are Lesnar’s hopes of recovery? Watching
him on the “SportsCenter” set, he appeared leaner than his fighting
physique. He admitted to losing 40 pounds. That is almost certainly
not the easy water weight that fighters sweat off making weight.
Immobilized in a hospital bed, fed intravenously, the majority of
Lesnar’s weight loss would be primarily lean muscle mass. How long
does it take to recover? It’s impossible to know. Lesnar claimed
he’s recovered 30 pounds of muscle: His career will depend on
whether he can also swiftly recover his explosive speed and
tremendous strength.

Beyond the physical injuries he’s sustained, some mention should be
made of the psychological injury endured by a sudden confrontation
with one’s own death. As Georges St. Pierre can attest, a
battle-ready mind is arguably the most crucial of a fighter’s
tools. The somber-faced, soft-spoken, introspective and almost
chastened Lesnar we saw on “SportsCenter” is someone very different
from the triumphant warrior exulting over the body of his fallen
foe at UFC 100. Can he fight as well?

With the physical and psychological injuries he’s sustained, can
the Brock
Lesnar of old ever return to the cage? The answer is beyond
what medical science can predict, but I suspect we’ll all get our
answer this summer.

Matt Pitt is a physician with degrees in biophysics and
medicine. He is board-certified in emergency medicine and has
post-graduate training in head injuries and multi-system trauma. To
ask a question that could be answered in a future article, e-mail
him at mpitt@sherdog.com.